“He just cannot sit still when doing his homework!” “Her attention span is so short!” “He often does things on impulse, without thinking of the consequences, and then gets punished for them!” – Have you observed your child in these situations before? Have you ever wondered if your child could have attention deficit hyperactivity disorder (ADHD)?
With increasing awareness of ADHD and its traits, it is indeed easy to assume a child as having ADHD when he/she is observed to behave in certain ways frequently. However, as a non-clinician, one cannot simply label a child as having ADHD unless there is a diagnosis to ascertain this. As concerned parents, what is the best way to understand why your child is “so active” or “has a very short attention span”? Doesn’t every kid have a little ADHD? What is notable is that others e.g. family members or school teachers, who are regularly in close contact with your child would have observed these behaviours too. It is understandable if parents were wondering about their child’s behaviour especially if they have received frequent feedback on it from significant others e.g. other family members or school teachers. Therefore, getting your child assessed by a clinician or psychologist is the way to go. For a diagnosis, the behaviours and difficulties associated with ADHD must interfere significantly (impair) with the child’s functioning such as doing poorly in school or having interpersonal relationship problems with peers.
Following recognition of suspected ADHD, parents with an active child or one with short a attention span should seek assessment from a clinical practitioner. As non-experts, they should not be using the term ‘ADHD’ to describe the child but instead refer to the symptoms that are impacting the child’s learning e.g. attentional difficulties. A typical assessment for ADHD consists of semi-structured interviews with parents and/or carers who have known the child for a considerable time. This interview will evaluate the symptoms that the child displays. Symptoms ratings will take into account:
- Onset – When did this symptom first appear? Symptoms must be present before age twelve (DSM-5)
- Duration – Symptoms must be present for six months or more
- Pervasiveness – Symptoms appear in more than one context
- Persistence – Symptoms must occur more frequently than typically expected at the child’s age
Hence, the person being interviewed must be familiar with the child’s functioning in different settings. The child may contribute to the interview if he/she is capable of responding to questions or the clinician could observe the child if the child is present during the interview. Besides the interview, the clinician may also utilise independent information such as school reports or social service reports, and observe the child in another setting.
When conducting ADHD assessments, the clinician will first record background information of the child and then assess symptoms across three diagnostic domains: inattention, hyperactivity and impulsivity. In order to reach a diagnosis, the clinician will need to add up the checks on the questions which parents/carers responded to on the symptoms ratings sheets as shown below.
The child must have six or more symptoms of inattention and/or hyperactivity/ impulsivity for a diagnosis e.g. 7 on the inattention domain indicates that the child has ‘inattention’.
Some of these symptoms must be present across settings and persisted significantly negatively impacted on academic and social functioning.
he clinician will then record these observations and consider comorbidity and differential diagnosis where necessary such as: Autism Spectrum Disorder, Cognitive Impairment, Speech and Language Impairment, Anxiety Disorders, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, Oppositional Defiance Disorder etc. If a comorbidity or differential diagnosis is suspected alongside ADHD during the interview, the clinician will consider whether common differential and co-existing conditions are present, and if they are primary (differential) e.g. cognitive impairment or secondary (co-existing) e.g. ADHD with dyslexia.
It is natural for parents/carers to feel apprehensive before bringing the child to an assessment especially when there is a lot about ADHD that may be unknown. What can be helpful is having a list of questions to ask the clinician or psychologist before, during and after the assessment (Appendix 1). Nevertheless, early diagnosis is crucial so that the child receives appropriate support and treatment, if necessary, to be able to function in school and behave appropriately at home and in a social setting. What should be avoided is a situation where a child’s daily functioning at home, in school, and other environment is impaired when he/she goes undiagnosed if he/she indeed has ADHD.
|What questions can parents ask a clinician?
|Examples of Impairment
Hani Zohra Muhammad
Educational Advisor and Educational Therapist
PATOSS Online Workshop: Using the ADHD Child Evaluation (ACE) to Collect and Recognise Characteristics of ADHD in Children
ADDitude ADHD Expert Webinar: The Right Questions to Ask Before, During, and After an ADHD Diagnosis